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Organization

SUPPORT CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. RENIE EFUETNGU LEKE TAZISONG PMHNP-BC (PMHNP-PMH)
(240) 765-5159
Entity
Organization

Contact information

Practice address
5609 PINE BLUFF CT, FREDERICK, MD 21704-6894
(240) 765-5159
Mailing address
5609 PINE BLUFF CT, FREDERICK, MD 21704-6894
(240) 765-5159

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
12/29/2025
Last updated
12/29/2025
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